Trauma Informed Approach Renee Dietchman Leslie Wiss Meet the - - PowerPoint PPT Presentation

Creating and Sustaining a Trauma Informed Approach

Renee Dietchman Leslie Wiss

Meet the Facilitators

Renee Dietchman, MA Licensed Psychologist Director of Clinical Services Leslie Wiss, MA, LPC Director of Trauma Informed Services

Great Circle is an agency that provides a unique spectrum of behavioral health services to children and families. With specialized programs and highly-trained professionals, we provide hope to those in difficult circumstances throughout Missouri and beyond.

Objectives

1. Understand the meaning of trauma and the difference between stress, traumatic stress and trauma 2. Understand the importance of trauma informed care and the need for having a trauma informed team 3. Increase familiarity with the essential elements of trauma informed care 4. Increase familiarity with the practices of Great Circle

TRAUMA MA

What do you think of when you hear the word “trauma”? What types of events are “traumatic”?

The Build Up….

Trauma Toxic Stress Stress

STRESS

Stress is defined as the brains response to any demand.

Positive Stressors Negative Stressors Getting married Conflict with others New job Losing a job College Financial problems Planning a vacation Trouble at school

TOXIC STRESS

Toxic stress refers to the physical and emotional responses of a child to events that threaten the life or physical integrity of the child or of someone critically important to the child (such as a parent or sibling). – Traumatic events overwhelm a child’s capacity to cope and elicit feelings of terror, powerlessness, and out-of-control physiological arousal. Toxic Stress Neglect Abuse (physical or sexual) Domestic violence Caregiver substance abuse

TRAUMA

Involves witnessing or experiencing an event that poses real or perceived threat – A child’s response to a traumatic event may have a profound effect on his or her perception of self, the world, and the future Person’s response involves intense fear, horror and helplessness, leading to extreme stress that overwhelms the person’s capacity to cope – Actual or threatened death – Actual or threatened serious injury – Threat to physical integrity

Types of Trauma

Complex Trauma

• Children who have

endured multiple interpersonal traumatic events from a very young age.

• Complex trauma

has profound effects on nearly every aspect of a child’s development and functioning.

Acute Trauma

• A single traumatic

event that is limited in time.

• During an acute

event, children go through a variety of feelings, thoughts, and physical reactions that are frightening in and

• f themselves and

contribute to a sense of being

• verwhelmed.

Chronic Trauma

• Refers to the

experience of multiple traumatic events.

• The effects of

chronic trauma are

• ften cumulative, as

each event serves to remind the child of prior trauma and reinforce its negative impact.

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Childhood Trauma and PTSD

Children who have experienced chronic or complex trauma are frequently diagnosed with PTSD. According to the American Psychiatric Association,1 PTSD may be diagnosed in children who have:

– Experienced, witnessed, or been confronted with one or more events that involved real or threatened death or serious injury to the physical integrity of themselves or others – Responded to these events with intense fear, helplessness, or horror, which may be expressed as disorganized or agitated behavior

Source: American Psychiatric Association. (2000). DSM-IV-TR ( 4th ed.). Washington DC: APA.

Symptoms of PTSD

Emotional Numbing

detachment estrangement loss of interest

Re- Experiencing

nightmares intrusive Memories flashbacks

arousal

irritability sleep problems startle

Impact of Trauma

The impact of a potentially traumatic event depends on several factors, including:

– The child’s age and developmental stage – The child’s perception of the danger faced – Whether the child was the victim or a witness – The child’s relationship to the victim or perpetrator – The child’s past experience with trauma – The adversities the child faces following the trauma – The presence/availability of adults who can offer help and protection

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Trauma

Trauma

Event that imposes threat and causes fear

• r helplessness

Near universal experience for people in mental health system ACE Study

• 2/3= 1 ACE
• More than 1:5

reported 3 or more ACEs

ACE Study

The ACE (Adverse Childhood Experiences)Study is an ongoing collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente Purpose of the Study

• Analyzing the relationship between multiple categories of childhood

trauma (ACEs), and health and behavioral outcomes later in life

• Examines participants across the life span (i.e., takes a “whole life”

perspective)

• Progressively uncovered how childhood stressors (ACE) are strongly

related to development and prevalence of risk factors for disease and health and social well-being throughout the lifespan

ACE Study

Major Findings

• Almost two-thirds of study participants reported at least one ACE, and

more than one in five reported three or more ACE’s

• The short-and long-term outcomes of childhood exposures to ACEs include

a multitude of health and social problems

• As the number of childhood ACEs goes up, so does the likelihood of social

(substance abuse, mental illness) and health problems (heart disease,

• besity)

ACE Study

Neurobiological Impacts of

Trauma on Brain Development

Trauma Is Often Misdiagnosed

Reactive Attachment Disorder

• Hypervigilant
• Irritability
• Withdrawn

Attention Deficit Hyperactive Disorder

• Hyperactive
• Inattentive
• Irritability
• Restlessness

Oppositional Defiant Disorder

• Irritability
• Vindictive
• Anger

Bipolar Disorder

• Impulsivity
• Anxiety
• Mood swings
• Dissociation

Conduct Disorder

• Aggression
• Destructive
• Breaks Rules

Effects of Trauma

Attachment Biology Mood regulation Self-Concept Dissociation Behavioral Control Cognition

Prevalence of Trauma

How common is trauma?

Statistics

In 2010, 695,000 unique children were substantiated victims of child maltreatment.

Neglect Physical Abuse Sexual Abuse Psychological Abuse

U.S. Department of Health and Human Services [DHHS], 2011)

Statistics

60% of children were exposed to violence or abuse in their homes or communities in 2009

Finkelhor, Turner, Ormrod, & Hamby, 2009

Over 65% of juvenile

• ffenders have mental health

consequences of trauma such as PTSD

Abram, Washburn, Teplin, Emanuel, Romero & McClelland, 2007; Arroyo, 2001; Burton, Foy, Bwanausi, Johnson & Moore, 1994; Cauffman, Feldman, Waterman, & Stiener, 1998

Statistics

TRAUMA INFORMED CARE

What does it mean to be trauma informed?

The Paradigm Change

Basic premise for organizing services is transformed…

• from: “What is wrong with you?”
• to: “What has happened to you?”

Change starts with an organizational shift from a traditional “top- down” environment to one that is based on collaboration with those who have experienced trauma and their families

Trauma Informed Care

Trauma Informed Services: – Incorporate knowledge about trauma in all aspects of service delivery. – Are hospitable and engaging for survivors. – Minimize victimization. – Facilitate recovery.

“Trauma-specific interventions are one piece of the puzzle, but I am talking about something much broader. We must adopt a systemic approach which ensures that all people who come into contact with the behavioral health system will receive services that are sensitive to the impact of trauma.” Linda Rosenberg, MSW, President and CEP National Council for Community Behavioral Healthcare

Trauma Informed Care Domains

Screening and Assessment Consumer Driven Care Trauma- Informed, Educated & Responsive Workforce Evidence Based Practices Safe and Secure Environments Community Outreach Performance Improvement

Trauma Informed Approach

Recognition that many behaviors and responses (often seen as symptoms) are directly related to traumatic experiences that

• ften cause mental health, substance abuse, and physical health

concerns. All components of the service system have been reconsidered and evaluated in the light of a basic understanding of the role that violence plays in the lives of people seeking mental health and addictions services. (Harris & Fallot, 2001).

Trauma Informed Practice

The Trauma Informed Staff:

• Understands the impact of

trauma on a child’s behavior, development, relationships, and survival strategies

• Can integrate that understanding

into engaging and planning for the child and family

• Understands his or her role in

responding to child traumatic stress The Essential Elements:

• Are the province of ALL

professionals who work in and with the child welfare system

• Must, when implemented, take

into consideration the child’s developmental level and reflect sensitivity to the child’s family, culture, and language

• Help youth achieve safety,

permanency and well-being

Essential Elements of Trauma Informed Practice

• 1. Maximize the child’s sense of safety.
• 2. Help children make new meaning of

their trauma history and current experiences.

• 3. Assist children in reducing
• verwhelming emotion.
• 4. Address the impact of trauma and

subsequent changes in the child’s behavior, development, and relationships.

• 5. Coordinate services with other

agencies.

• 6. Provide support and guidance to

child’s family and caregivers.

• 7. Manage professional and personal

stress.

• 8. Support and promote positive stable

relationships.

• 9. Utilize comprehensive assessment of

the child’s trauma experiences and their impact on the child’s development and behavior to guide services.

Trauma Informed Care at Great Circle

TIC Journey

Domain 1: Early Screening and Comprehensive Assessment

– Screening and Assessment procedures

Domain 2: Consumer Driven Care and Services

– Consumer engagement in cross-functional workgroups

Domain 3: Trauma-Informed, Educated and Responsive Workforce

– General trauma training and NMT/NME

Domain 5: Safe and Secure Environments

– Environmental Assessments

Domain 6: Engage in Community Outreach and Partnership Building

– Ferguson Supports

Neurosequential Model of Therapeutics (NMT)-

Site Certification Participants

Core Content

Dissemination

• 15 Participants
• Independent Studies
• Group Learning
• DVDs
• Readings
• Case-based staffing calls
• Metrics
• Participate in learning

sessions

• Incorporate material in
• rientation

Neurosequential Model in Education (NME)

Train-the-Trainer Participants Core Content Educational Staff

• 3 Participants
• Independent Learning
• Group Learning
• The Boy Who Was

Raised as a Dog

• DVD’s
• Readings
• Mini Metrics
• Fall of 2015

Challenges/Barriers

Size and Scope

Time

Consumer Engagement

The Success of TIC

Community Involvement Consumer Involvement Cross-functional Workgroups Strategic Planning Leadership Support

Questions

Renee Dietchman, MA, Licensed Psychologist Director of Clinical Services renee.dietchman@greatcircle.org Leslie Wiss, MA, LPC Director of Trauma Informed Services leslie.wiss@greatcircle.org